Abstract
Aims: To determine whether the research processes and interventions were implemented as planned and investigate how complex contextual factors influenced trial outcomes.
Methods: This prospective mixed-methods process evaluation used the Consolidated Framework for Implementation Research to guide data collection and inform analysis. We gathered qualitative and quantitative site-specific data throughout HRW, including staff interviews, project logs, meeting minutes, participant surveys. These data related to (1)implementation of trial processes (research design, recruitment/sample, follow-up, data collection); (2)CST; and (3)ABIC role, with fidelity and intervention integrity also examined.
Results: Both interventions were implemented broadly as planned, with diversity of culture, geography and administrative systems navigated throughout. The ABIC role refined over the study, with additional training/support introduced to the ABIC team as needed. Despite logistical challenges, mainly related to site/system-specific barriers, CST reached the target attendance numbers, with positive feedback and face-to-face sessions preferred. Sub-optimal identification of eligible hospital patients, COVID-19 and next-of-kin consent legislation were major reasons for under-recruitment (and impacted statistical power). The ~80% follow-up post-discharge was exemplary, given most participants returned to rural areas post-discharge, however, the volume/complexity of assessments made their completion challenging. HRW was under-resourced given the complex responses required to address system and contextual challenges.
Conclusion: In the context of COVID-19 and despite inconclusive results, HRW successfully implemented interventions, with completion and intervention fidelity achieved. The process evaluation documents significant lessons and makes recommendations for future research and rehabilitation services for Aboriginal people.